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Antidepressants—and, in particular, a class of medications known as “selective serotonin reuptake inhibitors” (SSRI’s)—have become a popular and garden-variety treatment for anxiety and mood disorders. Data from the National Center for Health Statistics has reportedly revealed that at least 13 percent of Americans over the age of 12 had taken an antidepressant in the last month— a number that only continues to rise. Strikingly, too, 68 percent of Americans on antidepressants have been using these medications long-term, as in two years or more.
For these Americans, getting off an antidepressant after the dark fog of depression has lifted can be very hard. While SSRI drugs do not technically meet the criteria of being an addictive substance, they can lead to physical dependency, creating withdrawal symptoms when discontinued: many people have tried unsuccessfully to get off a SSRI, only to end up back at the pharmacy counter refilling their prescription for Prozac, Lexapro or another SSRI.
And, in reality, for some people with severe chronic depression such as major depressive disorder, or for those with crippling anxiety disorders, the risks of coming off an antidepressant may indeed outweigh the benefits. For this reason, anyone who wants to stop an antidepressant should first consult their physician. While this article will offer tips for how to get off antidepressants, only your doctor can reliably tell you whether now is the time to try tapering off an antidepressant.
How SSRI Antidepressants Work
SSRI antidepressants work by increasing levels of the feel-good neurotransmitter in your brain known as serotonin. They do this by blocking the reuptake of serotonin in the brain, thereby making more serotonin available. And, because they primarily affect only serotonin—and not other neurotransmitters like dopamine or norepinephrine—they are described as “selective.”
The fact that SSRI’s only block the reabsorption of serotonin in your brain, as opposed to increase production of serotonin, helps to explain why these drugs can be so hard to break free from. This blocking mechanism on the part of SSRI’s in essence serves as a message to the brain that it does not need more serotonin, with the result that the brain decreases its own natural synthesis of serotonin. An experiment on rats, reported in Psychology Today, revealed this same phenomenon, showing that the administration of SSRI citalopram (also known as Celexa) dramatically decreased rats’ levels of serotonin.
When someone who has been using an antidepressant chooses to discontinue their use, then, what they may not know is that their brain has become accustomed to operating on a much lower level of serotonin, thanks to the SSRI. Once the antidepressant is out of their system, that person is left to function on a dramatically lower level of serotonin— which can soon prove miserable and impossible, driving them back to antidepressant use.
SSRI Withdrawal Symptoms
Antidepressants that affect serotonin—SSRIs and SNRIs, which also affect the neurotransmitter norepinephrine—are hard to quit for another reason. Cessation of use can result in a phenomenon known as “antidepressant discontinuation syndrome,” which is an unpleasant form of withdrawal. The symptoms, chronicled in a Harvard Health report, can include the following:
- Nausea, vomiting, diarrhea, loss of appetite, cramps
- Excessive sweating or flushing
- Changes in sleep, such as sleep interruptions or strange dreams or nightmares
- Dizziness, lightheadedness, and trouble with balance
- Tremors, restless legs, difficulties coordinating speech and even chewing
- Dramatic mood swings
- Anxiety, agitation, depression and/or irritability
- Strange sensations, such as ringing in the ears or “brain zaps” (a feeling that resembles electric shock)
Tapering vs. Cold Turkey – How to Get Off Antidepressants
The best way to protect yourself from experiencing these uncomfortable withdrawal symptoms is to taper off an antidepressant very slowly, under the direction of your doctor. (Not tapering gradually off an antidepressant, on the other hand, can leave you captive to severe and disabling discontinuation symptoms.) A gradual taper can also reduce the chances of a depression relapse, a Harvard Medical School study found. For some people, a gradual taper might mean an incremental lowering of one’s dose over weeks; for others, a gradual taper may take months. The duration of that taper may also depend on the antidepressant you’re taking, the dosage level, and whether the antidepressant is a longer-acting drug (and slower to leave the body) or a shorter-acting drug (quicker to leave the body).
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When to Get Off an Antidepressant
In addition to the “how” of getting off of an antidepressant is the “when.” This question should involve a frank conversation with your doctor, because it has to do with why you were prescribed the antidepressant in the first place— your diagnosis and the treatment regimen it entails. Someone with a very severe history of depression, who has had three or more episodes, may require long-term maintenance for years. Here are some other criteria that may require that you stay on an antidepressant for a long time, if not permanently:
- You have a history of substance abuse
- Mood disorders run in your family
- You have an anxiety disorder to dysthymia (chronic, low-grade depression)
- You habitually develop seasonal, depressive symptoms
Other Tips for Getting Off an Antidepressant
Here are some other tips for getting off an antidepressant:
- Pick the right time. The best time to discontinue an antidepressant will be when your life circumstances are stable, you’re feeling good, and you’re not under enormous stress. Some would add that the spring and summer are better times than the fall and winter, when rates of depression (which can be triggered by seasonal changes) are higher.
- Consider therapy. When it comes to depression, therapy can be an effective form of relapse prevention and an additional support as you taper off an antidepressant. In fact, therapy may be even more effective than that antidepressant you’re looking to kick. For example, the Michigan School of Psychology has noted that a good therapist is two times more effective than antidepressants in improving therapeutic outcomes, according to research.
- Practice a healthy daily lifestyle. Eating and exercising well, practicing healthy sleep hygiene, and minimizing the stressors in your life are powerful weapons against depression. Use them. Practicing good nutrition may also involve taking vitamins and supplements that support a positive and balanced mood. For example, the supplement 5-HTP, which increases your level of serotonin, may relieve depressive symptoms, according to research.
- Stay in close touch with your doctor. Should any complications arise in the process of discontinuing an antidepressant, call your doctor. They may be able to recommend gentler medications that can help you weather withdrawal and increase your resilience to depression.
- Know the difference between your discontinuation symptoms and a return of depression. Withdrawal symptoms will appear within days or weeks of stopping an antidepressant, whereas depression will take longer to develop. Withdrawal symptoms will also include physical, flu-like manifestations that don’t accompany depression. Another distinction: depression takes weeks to treat effectively, whereas discontinuation symptoms will disappear almost immediately upon restarting an antidepressant.
- Keep an open line of communication with close friends and family. Sometimes a close friend or family member will be quicker to notice any issues or warning signs in the aftermath of an antidepressant. They can be a helpful support network and source of feedback.
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